Transcript Prevention Works! - Embaixada Americana

BOM DIA’!
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Karen Garrett,
MA, CAP, CAPP
STRESS
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“Stress –related problems cost
American companies an average
of $750.00 per employee per year,
which for a company with 50
employees, can mean nearly
$40,000 a year.”
Stress is Internal
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External is Pressure
Stress is predictable and
preventable
What are the health benefit and
related costs to your company?
Workplace Factors
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Too much or to little to do
Lack of communication
Feeling unappreciated
Inconsistent performance evals
Unclear expectations/roles
Doubts about direction
Office politics – mistrust
Too many interruptions
Other Factors
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External Responsibilities &
Concerns
Poor Diet
Lack of physical activity
No support system
No “down” time
Lack of balance
Workplace
Wellness
Prevention Works!
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Why?
Drug Free Workplace Components
Drug Free Workplace Policy
Employee Education
Supervisor Education
EAPs
Drug Testing
Evaluating Effectiveness
In the Workplace…
-2/3 Of Drug Abusers
Employed!
-18-25 Peak Age Group
-More High-Income than Low
-10% of Employees Use Drugs
in the Workplace
- Estimated 1 in 5 Workers (1825) & 1 in 8 (26-34) Abuse
Drugs While on the Job
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Direct Costs
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300 % Higher
Medical Costs &
Benefits
Illicit Drug Users
5 X More Likely to
File Worker’s
Comp Claim
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Estimated $100
Billion per Year,
Directly &
Indirectly
Indirect Costs
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Functions at
About 67% of
Capacity
3 X More Likely to
Be Late
2.5 X More Likely
to Have
Absences of 8+
Days
Collectively –
Absent 32+ Days
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Drug Dealing in
Workplace
3.6 X More
Accidents: 40% of
Industrial
Fatalities & 47%
Industrial Injuries
Linked to Alcohol
Indirect Costs – cont…
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Bad Work Habits
Reduce Morale
More than 1/3 of
Injured
Employees had
Used Marijuana
within a few
Hours Prior to
Injury
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16 % of the
Seriously Injured
Employees had
been Drinking &
Smoking
Marijuana
U.S. Requires for…
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Transportation industry
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Government organization
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Billing more than $25,000 annually
A Drug Free Workplace
Program Can…
Reduce Costs
Preserve Investor/
Shareholder
interests
Protect Employees
& Customers
Result in Better
Service
Improve Products &
Services
Increase Profits
Help People Lead
Healthier Lives
Why have a Drug – Free
Workplace Program?
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Protects Health & Safety
Employees who are Free of
Alcohol & Other Drugs have fewer
accidents, make fewer mistakes
and are more productive!
Drug Free Program
Development
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Assess Organizational Needs
Identify Available Resources
Create Drug-Free Workplace
Policy
EAP? Drug Testing?
Train Supervisors
Educate Employees
Evaluate Program
Include Employees!
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Boosts Morale
Better Acceptance
Less likely to be challenged
through litigation than solely
management driven programs
Creating A Drug Free
Workplace Policy
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WHAT TO INCLUDE:
Rationale
Expectations & Prohibitions
Consequences & Appeals
Benefits & Assurances
Are Drug Tests
Accurate? Yes…
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Follow DHHS guidelines:
Certified Lab
Chain of Custody
Initial Screen
Confirmation Test
Medical Review Officer
Confidentiality
DRUG TESTING
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US Federal Programs Test for…
1) Marijuana
2) Cocaine
3) Amphetamines
4) Opiates
5) PCP
Many Employers Add…
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6) Barbiturates
7) Benzodiazepines
8) Methadone
9) Methaqualone
10) Propoxophene
Testing -Legal Concerns
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Is Testing Fair &
NonDiscriminatory?
Does Testing
Compromise
Right to Privacy?
U.S. COURTS
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Have upheld drug testing as
legitimate means of determining
employees’ ability to work
Majority of courts have held
businesses liable for accidents
caused by drug-using employees;
particularly when the company has
no Drug Free Workplace policy
WHEN TO TEST
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Require NO test
unless required
by regulation
and/or written
Company Policy!
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Pre-employment
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Post-accident
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Return to Work
TESTING…
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Reasonable
Suspicion/Probab
le Cause
Ensure training
Well documented
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Random
Consistent
implementation –
Every employee
in the pool MUST
have an equal
chance of being
selected.
Employee Education
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Setting the Tone
When & Where
Who
To Include...
The Minimum
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Policy Rationale
Details of the Policy – Including
Consequences
Available Help
Hazards of Use in the Workplace
How to Recognize
Abuse/Addiction & Treatment
Resources
Planning Checklist
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Obtain & Review Materials
Include Resource Contact Info
Plan Session(s) & Distribution
Involve Key Staff in Planning &
Follow-Up
Schedule follow-ups.
Provide Referral & Resource Lists.
Supervisor Education
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The Supervisor’s Role
What Supervisors Need to Know
Guidelines for Effective
Supervision
How to Provide Supervisor
Training
Supervisors Need to
Know…
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Rationale and
details of program
start-up &
implementation
Specific
Responsibilities
How to
Recognize Job
Performance
Problems
Supervisor Guidelines
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Be Attentive
Observe
Document
Focus on Job Performance
Be Thoughtful
Be Straightforward
Be Consistent
Maintain Confidentiality
Guidelines cont…
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Refer
Follow - up
Supervision Training
Checklist
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Decide How, When, Where, By
Whom, What Materials
Hold meeting
Distribute Materials
Schedule Follow-Up
Follow-Up
Employee Assistance
Programs
- Types -Benefits - How to Start
Evaluation
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Baseline Assessment
Implement Program
Review & Compare
Use Findings
QUALITY
INITIATIVES
Evidence Based Practices
EVIDENC- BASED PRACTICEAn intervention that shows consistent scientific evidence of
Being related to preferred client outcomes.
-Multiple randomized clinical trials
-Consensus reviews
-Expert opinion based on clinical observation
Prevention
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“Research findings guide
prevention science by identifying
risk and protective factors that
respectively increase and
decrease the likelihood of
substance use and abuse”
Risk & Protective
Factors
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DOMAINS
Individual
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Peer
SUBCATEGORY
OF RISK
Biological &
psychological
dispositions,
attitudes, values,
knowledge, skills,
problem
behaviors
Norms, activities,
bonding
Risk & Protective,
cont…
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Family
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School/Workplace
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Community
Society/
Environment
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Function,
management,
bonding
Bonding, climate,
policy, performance
Bonding, norms,
resources,
awareness,
mobilization
Norms,
policy/sanctions
Prevention Categories
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Universal
Selective
Indicated
Principles of Effective Treatment
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One size does not fit all.
Ready availability.
Address multiple needs.
Continual Assessment.
Adequate time.
Counseling – Individual & Group.
Medications.
Integrated Care.
Effective Treatment…
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Medical Detox – only 1st step.
Treatment does not need to be
voluntary.
Drug use must be monitored.
Health assessment & counseling.
Recovery is a Process & not an
event.
ASAM PPC – 2r
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Multi-dimensional assessment
Clinically driven treatment
Variable length of service
Continuum of Care
Assessment
Dimensions
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Acute Intoxication and/or withdrawal
potential
Biomedical conditions and complications
Emotional, behavioral or cognitive
conditions and complications
Readiness to change
Relapse, continued use, continued
problem potential
Recovery/Living enviornment
ASAM Levels of Service
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0.5: Early Intervention
I: Outpatient Treatment
II: Intensive OP/Partial
Hospitalization
III: Residential/Inpatient
IV: Medically Managed Intensive
Inpatient
MOTIVATIONAL
ENHANCEMENT
THERAPY (MET)
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Miller & Rollnick
Based on Prochaska &
DiClemente Change Model
STAGES OF CHANGE
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PRECONTEMPLATION
CONTEMPLATION
PREPARATION
ACTION
MAINTENANCE
TERMINATION
Benefits of Enhancing
Motivation
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Inspiring motivation to change
Preparing clients to enter treatment
Engaging & retaining clients in tx
Increasing participation &
involvement
Improving treatment outcomes
Encouraging a rapid return to tx if
symptoms recur
Clinicians can increase
motivation by…
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Focusing on client strengths
Using empathy more than authority
Recognizing co-occurring
disorders
Centering treatment on the
individual
Respecting the client’s autonomy
APPROACHES
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“Frames” –
Feedback/Responsibility/Advice/Menus/
Empathic Counseling/Self-Efficacy
Decisional balance exercises
Discrepancies between personal goals
and current behavior
Flexible pacing
Personal contact with clients in treatment
PRECONTEMPLATION
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Establish rapport
Raise doubts about patterns of use
Give info on risks, pros and cons of
use
CONTEMPLATION
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Discuss and weigh pros and cons
of using
Emphasize client’s free choice and
responsibility
Elicit self-motivational statements
PREPARATION
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Clarify goals and strategies
Offer menu of options
Negotiate contract or plan
ACTION
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Negotiate action plan
Acknowledge difficulties and
support attempts
Identify risky situations and coping
strategies
Help client find new reinforcers
Support perseverance
MAINTENANCE
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Support & affirm changes
Rehearse new coping strategies
Review goals
Keep in contact
ADDICTION
COUNSELING
COMPETENCIES
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A behavior comprised of requisite
knowledge, skills and attitudes that
plays an essential role in the
practice of addiction counseling.
TRANSDISIPLINARY
FOUNDATIONS
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A. UNDERSTANDING ADDICTION
B. TREATMENT KNOWLEDGE
C. APPLICATION TO PRACTICE
D. PROFESSIONAL READINESS
PRACTICE DIMENSIONS
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I. Clinical Evaluation
2. Treatment Planning
3. Referral
4. Service Coordination
5. Counseling
6. Client, Family & Community Education
7. Documentation
8. Professional & Ethical Responsiblities
COMPETENCIES
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KNOWLEDGE
SKILLS
ATTITUDES
Quality Improvement
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Compliance Systems
Quality Improvement Systems
Accrediting/Licensing Bodies